Master Subclavian Steal Syndrome with Picmonic for Medicine

Subclavian steal syndrome occurs due to the stenosis of the subclavian artery.

The stenosis is proximal to the origin of the vertebral artery, causing retrograde flow in the ipsilateral vertebral artery. This flow will result in hypoperfusion distal to the stenosis. It can also reduce cerebral perfusion during arm use.

Subclavian steal syndrome tends to occur more frequently in males than in females.

Diabetes may increase the risk of atherosclerosis formation, increasing occlusion possibility in subclavian steal syndrome.

Smoking can increase the risk of subclavian steal syndrome due to its relation to cause atherosclerosis.

On a blood pressure assessment, a disparity of at least 15 mmHg will be observed between the affected arm and the unaffected arm. The findings of delayed amplitude pulses on the affected side and a bruit in the supraclavicular fossa can also be seen.

Besides upper extremity exercise, vigorous exercise can also trigger symptoms in a patient. Vigorous exercise can cause upper extremity ischemia, resulting in arm pain, paresthesias, fatigue, or numbness.

Patients most commonly present as asymptomatic but can have certain symptoms. Neurological symptoms can occur secondary to vertebrobasilar insufficiency, which can present with dizziness, syncope, vertigo, blurring vision, disequilibrium, tinnitus, ataxia, or hearing loss.Exercise of the upper extremities and rotation of the face in the opposite direction can trigger these symptoms.

Arteriosclerosis is the most common cause of subclavian steal syndrome.

Takayasu arteritis is an inflammatory disease characterized by large-vessel vasculitis affecting the aorta and its branches (left common carotid, brachiocephalic, and left subclavian), resulting in thickening, narrowing, occlusion, or dilation of the involved arteries. It is also often associated with subclavian steal syndrome.

Coronary arterial bypass graft surgeries (CABG) can cause a complication called coronary subclavian steal syndrome which involves the left internal mammary artery (LIMA).

Treating the underlying disorder is an important modality in treating patients with subclavian steal syndrome. Surgery can also help symptomatic patients, including open surgical bypass and extra-anatomic revascularization.